On the 41st anniversary of Roe v. Wade, abortion is legal but nearly inaccessible in a number of states in the country. Currently, there are six states with just one public clinic left to offer abortions, all located in the central region of the United States.
The latest addition to this list is Missouri. The Planned Parenthood clinic in Columbia, Missouri stopped offering abortions in 2011 due to the military deployment of its doctor, leaving Planned Parenthood St. Louis as the only abortion provider in the state. That development has left it under the intense scrutiny of Operation Rescue, as well as the anti-abortion activists working with the Defenders of the Unborn, a group established in the mid 1980s to “sidewalk counsel” and divert pregnant people to local crisis pregnancy centers.
The “counselors” serve an additional purpose: they document and photograph any potential adverse medical issues that occur at the clinic, often forcing clinic workers to use extreme means to try and protect patients’ privacy. The anti-abortion activists track the arrival of any emergency personnel, both in an attempt to get information on the clinic — which the city has begun refusing to provide them — and to justify a new bill that would require the Planned Parenthood to be inspected at least every three months.
Onerous, unnecessary medical restrictions, constant surveillance, and the pressure of being the sole provider together can contribute to near battle-like conditions both for staff and patients. So what is it like, and what is the future of abortion access in Missouri under these conditions? The following is an interview with Dr. Colleen McNicholas, the doctor who provides services in the last clinic in the state.
Robin Marty: What is the biggest challenge with providing abortions, knowing that you are the only clinic in Missouri and, because of it, that there is so much scrutiny on every abortion you perform or any issues that can occur at the clinic?Dr. Colleen McNicholas, DO, MSCI: I wish there was just one issue I could identify as “the biggest” challenge to providing abortions. The reality is that the biggest challenge is different depending on from what perspective you think about the issue.
From the perspective of the women we care for, the biggest issue is economic. In Missouri, insurance, both private and public, are prohibited from covering the cost. That leaves women scraping by to find the cash to get the care. The amazing thing about abortion care is that it is probably the only surgical procedure that has not increased in cost over time.
From the perspective of the clinic, it is difficult to work under the banner of only abortion clinic. It means you take care of everyone, complicated or straightforward. It also means that you are ready for inspection at any moment and you expect the protesters to call the department of health for every transfer. Of course, patient care is always the most important thing and physicians will always err on the side of caution when deciding if a woman needs a higher level of care.
From a provider standpoint, what is most challenging to me is accommodating a changing population of women. Obesity, rates of previous cesarean section, and the prevalence of drug abuse can make taking care of patient in the out-patient setting challenging. The difficulty lies in finding a way for them to get the procedure when they aren’t a candidate for an out-patient procedure, but can’t afford much anything else.
RM: Has the constant presence of Defenders for Life/Operation Rescue allies had an impact, either on your own life, impact on the workers and volunteers at the clinic, or on the patients who come in?Dr. McNicholas: I don’t want to give them too much credit. We — providers, patients, and clinic staff — know they are there, but in general try to ignore them. I am addressed by first name and with a litany of the same questions every time I drive into the clinic. The only impact their presence has on me is to strengthen my resolve to show up and provide good care to women who need it. Most patients express the same sorts of thoughts. They often share their frustration with the protesters’ assumptions that they know what is best for other people. I oftentimes hear anger, particularly from the partners and support people who accompany these women.
RM: Now that the clinic in mid-Missouri has closed, how much has that increased the number of patients who come in? Are they forced to wait until later in gestation to obtain a termination? How much further are many of them traveling now to see you?Dr. McNicholas: This continues to be a huge problem for women, and really is a cycle that is fostered by the legislative restrictions of this state. With a 24-hour waiting period, women are required to have a minimum of two visits, but it can be as many as three depending on gestational age and type of abortion they choose (medical vs. surgical). This translates into arranging child care more than once. Finding transportation for the 90+ mile drive. Asking a friend or loved one to take off work for two days to accompany you. Lost wages for two days…. And all of that is the most ideal of situations. If they are in the second trimester when they present, the procedure will be performed over two days, which requires a hotel stay in St. Louis for a night.
All of this is contingent of course on the physician deciding that you are a safe candidate for an out-patient procedure. Access is a terrible problem. We have taken care of more than a few women who have told us they ordered “pills” online because they didn’t think they could get it together to get to St. Louis. Access restrictions do not make abortion rarer, they make it less safe!
RM: One of the proposals for the legislature this year is an extension from 24 hours to 72 hours for a wait for an abortion. I’ve written in the past that because of the clinic in Granite Falls just across the border, if such a bill passed it could inadvertently end abortion in Missouri, just because everyone would travel to Illinois instead. Do you have any concerns that could happen? And do you tend to feel like there is a lot of pressure on you, and the clinic itself, as having so much responsibility when it comes to ensuring Missouri doesn’t become the first state to be abortion-free?Dr. McNicholas: I think the anti-choice legislators would love to think they are on the verge of an “abortion-free state. ” Even with added restrictions, women will still find a way. They will still come to the clinic. They will still have abortions. What I really hope happens, is that they get so angry about the unjustified intrusion into their medical care that they stand up and fight back.
Advocacy for me has been such an exciting and fulfilling part of my job. I will admit in the beginning I felt like my advocacy was that I provided abortions when many people wouldn’t. But as I grew in my own journey as a parent and as a provider, I actually realized that for me that wasn’t enough. As a woman, parent, and physician I felt so strongly that a group of almost all male, almost all non-medically trained, and all politically focused legislators had no business in my exam room — either as a physician or a patient. With the support of my colleges and the help of Physicians for Reproductive Health, I have been so lucky to have had the opportunity to develop my advocacy voice.